Aimee双语小讲堂 第三讲：远端小脑出血

Aimee   上海某医院

80-year-old woman with frontal bone mass 

80岁老年女性，额骨肿块

History: An 80-year-old woman presents for resection of a long-standing transosseous mass of the right frontal bone. The patient has no history of malignancy.

病史：80岁老年女性，手术切除右侧额骨跨骨肿块。患者无恶性肿瘤病史。

Preoperative and postoperative noncontrast-enhanced CT images, including one in bone window, are shown below. Click to enlarge.

下图为术前及术后平扫CT图像（包含骨窗）。点击放大

Findings

影像学表现

· Preoperative CT: Axial CT image demonstrates a trans osseous mass in the right frontal bone.

· 术前CT：横断面CT可见右侧额骨跨骨占位

· Postoperative CT: Axial and coronal CT images demonstrate postsurgical changes of right frontal craniotomy with resection of the mass. There is a large, left cerebellar hemispheric hemorrhage with part of the hemorrhage along the cerebellar folia.

· 术后CT：横断面积冠状面CT可见右侧额骨肿块切除术后改变。可见左侧小脑半球较大面积出血，部分沿小脑镰分布。

Differential diagnosis

鉴别诊断

· Hypertensive hemorrhage

· Cavernous hemangioma

· Hemorrhagic metastasis

· Hemorrhagic transformation of infarct

· Remote cerebellar hemorrhage

· 高血压性出血

· 海绵状血管瘤

· 转移灶伴出血

· 脑梗死后出血

· 远端小脑出血

Diagnosis: Remote cerebellar hemorrhage following mass resection of meningioma

诊断：脑膜瘤切除术后（病灶）远端小脑出血

Key points

Remote cerebellar hemorrhage (RCH)

远端小脑出血

· Remote cerebellar hemorrhages are uncommon complications of supratentorial craniotomies. The term remote refers to the location of the hemorrhage distant from the craniotomy site.

· 远端小脑出血属于罕见的幕上手术并发症。“远端”一词是指出血离术区距离较远。

· The underlying pathophysiology is not well understood, but it is thought to be due to the occlusion of veins in the posterior fossa and subsequent hemorrhagic infarction.

· 病理病生机制未知，可能是和后颅窝静脉栓塞及继发的梗死性出血相关。

· Patients most commonly present with altered mental status. They may also experience delayed awakening from anesthesia.

· 患者常表现为精神状态改变，并可能出现麻醉后延迟苏醒。

· In the proper clinical setting, this diagnosis should be considered. The clinical course of remote cerebellar hemorrhage tends to be benign in contradistinction to other causes of intracranial hemorrhage.

· 在特定的临床情况中，需要考虑该诊断。和其他原因引发的颅内出血相比，远端小脑出血的转归一般较好。